National Intrepid Center of Excellence

INVISIBLE WOUNDS

Veterans Let Slip the Masks of War: Can This Art Therapy Ease PTSD?

01.08.16 5:01 AM ET

Service members suffering from PTSD often feel like they’re wearing a mask. Melissa Walker asks them to make one.

Walker, an art therapist and healing arts coordinator with the National Intrepid Center of Excellence (NICoE) at Walter Reed National Military Medical Center runs an art therapy program in which service members returning home from Iraq and Afghanistan with PTSD or a traumatic brain injury (TBI) are asked to make papier-mâché masks to express their feelings.

“It’s actually the first art directive they’re introduced to as they come through the program,” Walker told The Daily Beast. “These are service members that sometimes have trouble verbalizing what they’re struggling with and these masks, along with all the artwork [they] create, help to make their invisible wounds visible.”

The results are stirring. One mask, striped in red and black with hollow chrome-colored eyes, is wrapped in razor wire with a lock where its mouth should be. Another haunting paper face, eyes bloodshot, mouth agape, is being crushed by a vice bearing the acronyms for traumatic brain injury and post-traumatic stress disorder.

The masks are so evocative and insightful that the National Endowment for the Arts (NEA), through its Military Healing Arts partnership, is now funding an analysis of 400 of them at Drexel University in Philadelphia.

“What this gives us is a chance to understand the military experience from the service member’s perspective,” said Dr. Girija Kaimal, a professor of creative arts therapy in Drexel’s College of Nursing and Health Professions and a collaborator on the study, in a press release.

The masks, Kaimal explained, are especially significant because they provide an outlet for non-verbal expression at a time when verbal communication may be challenging for the service members. People with PTSD, as the Department of Veterans Affairs (DVA) notes, may practice extreme avoidance of traumatic thoughts and feelings, which “can interfere with your emotional recovery and healing.”

Neuroimaging studies have also shown that PTSD can decrease activity in Broca’s area of the brain, which plays a key role in speech and language.

“A lot of research will tell you that when you’re in a traumatic experience, the part of the brain that controls speech shuts down,” said Kaimal. “So having a nonverbal way—such as art—to communicate is key to understanding what they’re going through.”

According to the DVA, PTSD affects between 11 and 20 percent of veterans from Operations Iraqi Freedom and Enduring Freedom. Traumatic brain injury, which heightens the risk of depression and PTSD, accounts for 22 percent of combat casualties in Iraq and Afghanistan, according to the Department of Defense and the Defense and Veteran’s Brain Injury Center.

Kaimal and her colleagues at Drexel are hoping to better understand the psychology of these wounded service members through themes found in the masks. For instance, many participants in the art therapy programs cut the masks, or embed shrapnel in the papier-mâché molds, to illustrate their pain. Needles and nails are often inserted into the foreheads.

There are other common themes, added Walker, who has now seen close to 1,000 masks come out of the program.

“The one that we’re seeing the most is the split sense of self, or the dual identity,” she told The Daily Beast. “One side of the mask is maybe who they are when they’re deployed, or in theater, or the part of themselves that was injured, and the other part is the part of themselves that they think remains intact, or who they are when they’re at home with their families.”

Another recurring motif is the manipulation of mouths. Many service members paint over the mouths of the mask, stitch them shut, or even place gags in them.

“Many of the masks have guilt, grief written on them or depicted,” said Kaimal. “They have things on their mouths to show that they aren’t allowed to talk or [that they] feel they should talk about what they’re feeling.”

Ultimately, creating the masks can help service members do just that: talk.

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“The art-making bypasses [problems with speech and language] and accesses different parts of the brain that they can then use to express and apply words to what they’ve created,” explained Walker, noting that this approach may prove easier for some service members than simply “sitting down with a talk therapist and trying to describe what’s occurred.”

According to Kaimal and Walker, the masks can sometimes even help to alleviate symptoms of PTSD. In one case study that is being highlighted at Drexel, a service member who was deployed in Iraq recreated a bloody face that haunted him in PTSD-related flashbacks. Over the course of art therapy, he put his mask into a box and closed it, significantly reducing the frequency of his flashbacks as a result.

“Through art therapy with Ms. Walker, he was able to externalize a lot of feelings that were trapped in him,” said Kaimal.

One unintended consequence of the mask-making program is that it has helped those outside the military better understand the effects of TBI and PTSD. Walker told The Daily Beast that, although service members create an array of artwork during her program, the masks often elicit the most attention from outsiders and tourists.

“This can bring us a little closer to the experience because it gives them a way to show us, rather than tell us,” she said.

For the NEA Military Healing Arts Partnership, which began in 2011 when the National Endowment for the Arts first helped NICoE expand the art therapy program at Walter Reed, the mask-making is one of many recent successes. In 2013, the partnership brought the same art therapy program to the Fort Belvoir Community Hospital Brain Wellness Center in Virginia and, in late 2015, they announced a further expansion in collaboration with the Department of Defense.

Art is indeed the right word for these masks. Many service members, Walker said, are astonished by the quality of what they manage to make in the first week of her program, often without any formal training or experience.

“What I tell them is because they’ve been through so much, they have a lot to express,” she said.